FHIR IG analytics| Package | ca.on.oh.setp.iar.dev |
| Resource Type | Bundle |
| Id | Example-bundle-message-submit-preliminaryscreener.json |
| FHIR Version | R4 |
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FHIR
FHIRsmith{
"resourceType": "Bundle",
"id": "Example-BundleMessageSubmitPreliminaryScreener",
"identifier": {
"system": "http://ontariohealth.ca/fhir/NamingSystem/id-civica-iar-assessment",
"value": "3306c04a-77a7-4179-aafd-5ef039b62b11"
},
"type": "message",
"timestamp": "2024-01-11T13:30:00+00:00",
"entry": [
{
"fullUrl": "urn:uuid:849ae23e-1e38-40e5-9173-39ac38156d6e",
"resource": {
"resourceType": "MessageHeader",
"eventCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/message-event-code",
"code": "1",
"display": "submit-assessment"
},
"sender": {
"reference": "urn:uuid:5f85e9b2-80b4-40ac-a4db-5971ee33f6b3"
},
"source": {
"name": "Submitting application name, e.g. HSSO Service Module, could be the same as client_id",
"software": "Vendor Software name used to implement source application with version, e.g. HSSO",
"version": "Source application version",
"endpoint": "https://hsp.on.ca/ehr/fhir/A1"
},
"focus": [
{
"reference": "urn:uuid:54286859-fea2-4171-ad1b-be16e3f11d1e"
}
]
}
},
{
"fullUrl": "urn:uuid:e69cb8dc-3a4e-45bf-a304-c43c516b498e",
"resource": {
"resourceType": "Encounter",
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "VN"
}
]
},
"system": "urn:ietf:rfc:3986",
"value": "83286859-fea2-4171-ad1b-be16e3f11d11"
}
],
"status": "planned",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "IMP",
"display": "inpatient encounter"
},
"contained": [
{
"resourceType": "Coverage",
"id": "iA7a",
"status": "active",
"type": {
"coding": [
{
"system": "http://cihi.ca/fhir/irrs/CodeSystem/irrs-coverage-type",
"code": "INPUBLICPOL"
}
]
},
"beneficiary": {
"reference": "urn:uuid:70279fa5-ee26-4f2a-935d-ad54deb3ef70"
},
"period": {
"start": "2025-01-02"
},
"payor": [
{
"identifier": {
"system": "http://cihi.ca/fhir/NamingSystem/on-ministry-of-child-and-youth-services-submission-identifier",
"value": "52465"
}
}
]
},
{
"resourceType": "Account",
"id": "paymentSources",
"status": "active",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/v3/ActCode",
"code": "PBILLACCT"
}
]
},
"coverage": [
{
"coverage": {
"reference": "#iA7a"
}
}
]
},
{
"resourceType": "Location",
"id": "dischargedTo",
"status": "active",
"type": [
{
"coding": [
{
"system": "http://cihi.ca/fhir/irrs/CodeSystem/irrs-service-delivery-location-role-type",
"code": "SEMIND",
"display": "Assisted living or semi-independent living"
}
],
"text": "Assisted living or semi-independent living"
}
]
}
],
"type": [
{
"coding": [
{
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/program-type",
"code": "A354",
"display": "Case Management and Service Coordination"
}
],
"text": "Case Management and Service Coordination"
}
],
"subject": {
"reference": "urn:uuid:70279fa5-ee26-4f2a-935d-ad54deb3ef70"
},
"account": [
{
"reference": "#paymentSources"
}
],
"location": [
{
"location": {
"reference": "#dischargedTo"
}
}
],
"period": {
"start": "2024-01-01",
"end": "2025-02-01"
},
"serviceProvider": {
"reference": "urn:uuid:5f85e9b2-80b4-40ac-a4db-5971ee33f6b3"
}
}
},
{
"fullUrl": "urn:uuid:5f85e9b2-80b4-40ac-a4db-5971ee33f6b3",
"resource": {
"resourceType": "Organization",
"identifier": [
{
"system": "https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-provider-upi",
"value": "101473083042"
}
],
"name": "X Organization Community Care",
"telecom": [
{
"system": "phone",
"value": "+1-416-555-1234",
"use": "work"
}
],
"address": [
{
"use": "work",
"type": "physical",
"line": [
"123 Wellness Avenue"
],
"city": "Toronto",
"state": "ON",
"postalCode": "M5G 2C4",
"country": "CA"
}
]
}
},
{
"fullUrl": "urn:uuid:70279fa5-ee26-4f2a-935d-ad54deb3ef70",
"resource": {
"resourceType": "Patient",
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "JHN"
}
]
},
"system": "https://fhir.infoway-inforoute.ca/NamingSystem/ca-on-patient-hcn",
"value": "8702501944"
}
],
"name": [
{
"family": "Clarke",
"given": [
"Levi Jason"
]
}
],
"telecom": [
{
"system": "phone",
"value": "435-556-8897",
"rank": 1
},
{
"system": "email",
"value": "levi.clarke@example.com",
"rank": 2
}
],
"gender": "male",
"birthDate": "2000-10-22",
"address": [
{
"use": "home",
"type": "physical",
"line": [
"45 Royal street"
],
"city": "King",
"state": "ON",
"postalCode": "G3L3H1",
"country": "CAN"
}
],
"maritalStatus": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
"code": "S",
"display": "Never Married"
}
],
"text": "Single"
},
"communication": [
{
"language": {
"coding": [
{
"system": "urn:ietf:bcp:47",
"code": "en",
"display": "English"
}
],
"text": "English"
}
}
]
}
},
{
"fullUrl": "urn:uuid:54286859-fea2-4171-ad1b-be16e3f11d1e",
"resource": {
"resourceType": "QuestionnaireResponse",
"id": "questionnaireresponse-interrai-preliminary-screener",
"status": "completed",
"authored": "2025-12-12T17:52:06.818Z",
"questionnaire": "http://ontariohealth.ca/fhir/iar/Questionnaire/interrai-preliminary-screener|1.1",
"item": [
{
"linkId": "A",
"text": "Section A: Identification Information",
"item": [
{
"linkId": "A1",
"text": "1. Name",
"item": [
{
"answer": [
{
"valueString": "Sansa"
}
],
"linkId": "A1a",
"text": "a. First Name"
},
{
"answer": [
{
"valueString": "Snow"
}
],
"linkId": "A1b",
"text": "b. Middle Name"
},
{
"answer": [
{
"valueString": "Lark"
}
],
"linkId": "A1c",
"text": "c. Last Name"
},
{
"answer": [
{
"valueString": "Jr"
}
],
"linkId": "A1d",
"text": "d. Jr/Sr"
}
]
},
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/sex",
"code": "M",
"display": "Male"
}
}
],
"linkId": "A2",
"text": "2. Sex"
},
{
"answer": [
{
"valueDate": "2000-12-06"
}
],
"linkId": "A3",
"text": "3. Birthdate"
},
{
"linkId": "A4",
"text": "4. Numeric identifiers",
"item": [
{
"answer": [
{
"valueString": "8702501944"
}
],
"linkId": "A4a",
"text": "a. Health Card Number"
},
{
"answer": [
{
"valueCoding": {
"system": "http://canadapost.ca/CodeSystem/ProvinceCodes",
"code": "ON",
"display": "Ontario"
}
}
],
"linkId": "A4b",
"text": "b. Province or Territory issuing health card"
},
{
"answer": [
{
"valueString": "20564"
}
],
"linkId": "A4c",
"text": "c. Case Record Number"
}
]
},
{
"linkId": "A5",
"text": "5. PROVINCE OR TERRITORY AND POSTAL CODE OF USUAL LIVING ARRANGEMENT",
"item": [
{
"answer": [
{
"valueCoding": {
"system": "http://canadapost.ca/CodeSystem/ProvinceCodes",
"code": "ON",
"display": "Ontario"
}
}
],
"linkId": "A5a",
"text": "a. Province /Territory"
},
{
"answer": [
{
"valueString": "M9A 0A2"
}
],
"linkId": "A5b",
"text": "b. Postal Code of usual living arrangement"
}
]
},
{
"answer": [
{
"valueString": "54668"
}
],
"linkId": "A6",
"text": "6. Facility/Agency Identifier"
},
{
"answer": [
{
"valueCoding": {
"code": "eng",
"display": "English"
}
}
],
"linkId": "A7",
"text": "7. Primary Language"
},
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "0",
"display": "No"
}
}
],
"linkId": "A8",
"text": "8. Interpreter Need"
},
{
"answer": [
{
"valueString": "improve independence and mobility"
}
],
"linkId": "A9",
"text": "9. Reasons for Referral"
},
{
"answer": [
{
"valueDate": "2025-12-01"
}
],
"linkId": "A10",
"text": "10. Assessment Rerference Date"
}
]
},
{
"linkId": "B",
"text": "Section B: Screener",
"item": [
{
"answer": [
{
"valueCoding": {
"code": "1",
"display": "Modified independence"
}
}
],
"linkId": "B1",
"text": "1. Cognitive Skills for Daily Decision Making"
},
{
"linkId": "B2",
"text": "2. ADL Self Performance",
"item": [
{
"answer": [
{
"valueCoding": {
"code": "0",
"display": "Independent or set up help only"
}
}
],
"linkId": "2a",
"text": "a. Bathing"
},
{
"answer": [
{
"valueCoding": {
"code": "0",
"display": "Independent or set up help only"
}
}
],
"linkId": "2b",
"text": "b. Personal Hygiene"
},
{
"answer": [
{
"valueCoding": {
"code": "1",
"display": "Supervision or any physical assitance"
}
}
],
"linkId": "2c",
"text": "c. Dressing Lower Body"
},
{
"answer": [
{
"valueCoding": {
"code": "0",
"display": "Independent or set up help only"
}
}
],
"linkId": "2d",
"text": "d. Locomotion"
}
]
},
{
"answer": [
{
"valueCoding": {
"code": "1",
"display": "Absent at rest, but present when performed moderate activities"
}
}
],
"linkId": "B3",
"text": "3. Dyspnea (Shortness of Breath)"
},
{
"answer": [
{
"valueCoding": {
"code": "1",
"display": "Good"
}
}
],
"linkId": "B4",
"text": "4. Self Reported Health"
},
{
"linkId": "B5",
"text": "5. Instablity of Conditions",
"item": [
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
],
"linkId": "5a",
"text": "a. Conditions/diseases make cognitive, ADL, mood, or behaviour patterns unstable (fluctuating, precarious, or deteriorating)"
},
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
],
"linkId": "5b",
"text": "b. Experiencing an acute episode, or a flare-up of a recurrent or chronic problem"
}
]
},
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/no-or-na-could-not-respond",
"code": "8",
"display": "Could Not (would Not) respond"
}
}
],
"linkId": "B6",
"text": "6. Self-Reported Mood"
},
{
"linkId": "B7",
"text": "7. Informal Helper Status",
"item": [
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
],
"linkId": "7a.",
"text": "a. Primary informal helper expresses feelings of distress, anger, or depression"
},
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
],
"linkId": "7b.",
"text": "b. Family or close friends report feeling overwhelmed by person’s illness"
}
]
}
]
},
{
"linkId": "C",
"text": "Section C: Summary",
"item": [
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
],
"linkId": "C2",
"text": "2.a. InterRAI CHA Assessment Required"
},
{
"answer": [
{
"valueCoding": {
"system": "http://ontariohealth.ca/fhir/iar/CodeSystem/yes-no",
"code": "1",
"display": "Yes"
}
}
],
"linkId": "C2.1",
"text": "2.b. Client Agrees to have interRAI CHA Completed"
},
{
"answer": [
{
"valueDate": "2025-12-02"
}
],
"linkId": "C4",
"text": "Date Screener Signed as Complete**"
}
]
}
],
"subject": {
"reference": "urn:uuid:70279fa5-ee26-4f2a-935d-ad54deb3ef70"
},
"encounter": {
"reference": "urn:uuid:e69cb8dc-3a4e-45bf-a304-c43c516b498e"
},
"author": {
"reference": "urn:uuid:5f85e9b2-80b4-40ac-a4db-5971ee33f6b3"
}
}
}
]
}